PANEL SYSTEM.

Auckland Star, Volume LXVII, Issue 273, 17 November 1936, Page 8

PANEL SYSTEM.

METHOD IN ENGLAND. "AMBULANCE STANDARD." SOME MEDICAL VIEWS. Jn expressing the hope that the Government'would not introduce the panel system as applied to medical services Dr. J. P. Hastings, a member of the Auckland Hospital Board, said to-day that the panel system in England had lowered the standard of, the general practitioner; and that the general practitioner's standard in New Zealand was higher than in England. He considered that the practitioner in England had been degraded to the standard of the ambulance mail. "That is contrary to the spirit of tilings," he said. "Medical service is to safeguard the health of the people and the panel system docs not make for that effectively. A medical man in England has to have a big panel if he is to keep up his own standard of living. Ho cannot do it on a small panel, aspointed out by Sir Arthur Newsholmc, who is recognised as the greatest authority in the British Empire on the subject." Dr. Hastings said that he could support a system, that would eliminate the commercialism that was at present in vogue in the medical world. He quoted an instance that had recently happened when he had been informed that a man had visited three surgeons to obtain a price for the removal of a goitre. One had quoted £80, one £60 and the third £40. The lowest price was accepted. "It only needs the auction room to complete the picture," added Dr. Hastings. He went on to say that Sir Arthur Newsholmo had expressed the view that the general practitioner should be the most important unit in any scheme for national health insurance, for the reason that he was the first person to come in contact with a patient. The whole idea of such a scheme was to prevent sickness and disease, and that could only be accomplished Iby taking cases in their early stages. Not in Public's Interests. "The general practitioner is in the same position as the advance post of an army," continued Dr. Hastings. "Disease is. the enemy and he is out to detect it— to diagnose the' case. The panel system is fatal to the best interests of the public .and the medical profession. In France and Sweden there are schemes in vogue under which the gelneral practitioner is paid for his services, but in England lie is paid per capita. "Although I am in favour of a properly organised State medical service as ; the ultimate goal to be aimed for, tile meantime the French and, Swedish systems could well be introduced as a commencement. Any scheme would have to safeguard the public from exploitation. With a properly-organised State system there would be team work and a practitioner would not be overworked. Under the panel system a doctor is on tap for 24 hours out of the 24. A medical man called out, say, at midnight to attend to an acute appendix case or a ruptured gastric ulcer will not bo fresh to do the job after having worked the whole day on other cases. The doctor is nothing but a slave under the panel system. Team work is an essential under a properly-organised and controlled system." Other Views Expressed. While some medical practitioners declined to express any opinion concerning the panel or any other system of mcdical control, others were of opinion that the panel system, where so many doctors in each district had a panel of patients and were paid at so much a head by the State, would not be in the best interests of the profession. "The Government desires to bring in a scheme? was the c6mment of one doctor. "What that scheme is nol>ody seems to know, but I should say from the questionnaire that the aim is a panel system. This has been in operation in England for about a quarter of a century, but from all the information I have received it has not raised the standard of the profession. A practitioner to make anything like a decent income has to have an exceedingly large panel of patients and he can practically do what he likes about them. They are his concern alone. I hope that system is not introduced into New Zealand. Sir E. Farquhar Buzzard, Regius professor of medicine in the University of Oxford and president of the B.M.A. in England, writing recently in- the "British Medical Journal," says, inter alia: "Any medical service which aims at prevention and early detection of disease must provide the doctor with ample time to carry out his work, and I.have no hesitation in adding the better educated the doctor the more time will he require. The chicf flaw in a badly organised service, such as that which •has evolved in this country during the last century, is lack of" time, and both the general practitioner and the consultant, in order to earn a living wage, are frequently obliged to undertake far more work than they can deal with efficiently in the hours at their disposal. Health Centres. "Under the present- system it would be necessary to double the number of doctors in order to obtain an adequate service, and such a measure would rapidly lead to their starvation. .. . . Fortunately sciences other than that of medicine have not been idle meanwhile, and modern means of communication and of transport not only save valuable time, but make possible the establishment of health centres where the personnel and special equipment necessary for skilled diagnosis and treatment are easily accessible to, and capable of serving, large, surrounding areas of population. "But every medical man and woman within such an area must belong to the service. * The day has passed when any doctor, whether in general or consulting practice, can legitimately pretend to carry on as an isolated and independent unit ready to meet all the requirements of his patients. In his own interests as .well as those of his patients, he must be part of a team recognising the responsibilities and enjoying the advantages which team recognising the responsibilities and enjoying the advantages which team work alone can provide. . . ."